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Audience Research on Self-Management Education, Phase III
CDC and ATSDR Health Message Testing System
OMB: 0920-0572
IC ID: 213762
OMB.report
HHS/CDC
OMB 0920-0572
ICR 201501-0920-003
IC 213762
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:
2024-10-18 - Revision of a currently approved collection
2021-08-31 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-0572
Audience Research on Self-Management Education, Phase III
Form and Instruction
0920-0572 Attachment 4 Screener_10282014
Attachment 4 Screener_10282014.docx
Form and Instruction
0920-0572 Attachment 3 Mod Guide_10282014
Attachment 3 Mod Guide_10282014.docx
Form and Instruction
Attachment 1 Research Plan and Burden_10282014.docx
Attachment 1 Research Plan and Burden_10282014
IC Document
Attachment 2 Materials_v3 10282014.docx
Attachment 2 Materials_v3 10282014
IC Document
Attachment 5 Consent_10 27.docx
Attachment 5 Consent_10 27
IC Document
HMTS Expedited Review Form_SME 10282014 V3.docx
HMTS Expedited Review Form_SME 10282014 V3
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Audience Research on Self-Management Education, Phase III
Agency IC Tracking Number:
0920-15DC
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-0572
Attachment 4 Screener_10282014
Attachment 4 Screener_10282014.docx
Yes
Yes
Fillable Printable
Form and Instruction
0920-0572
Attachment 3 Mod Guide_10282014
Attachment 3 Mod Guide_10282014.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
160
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
160
0
0
0
0
160
Annual IC Time Burden (Hours)
134
0
0
0
0
134
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment 1 Research Plan and Burden_10282014
Attachment 1 Research Plan and Burden_10282014.docx
11/10/2014
Attachment 2 Materials_v3 10282014
Attachment 2 Materials_v3 10282014.docx
11/10/2014
Attachment 5 Consent_10 27
Attachment 5 Consent_10 27.docx
11/10/2014
HMTS Expedited Review Form_SME 10282014 V3
HMTS Expedited Review Form_SME 10282014 V3.docx
11/10/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.